MEDICARE: BETHANY BOSWELL MS CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant	34989	TX
2	235Z00000X	Speech-Language Pathologist	107967	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275849762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY BOSWELL MS CCC-SLP

Provider Business Mailing Address
First Line	:	6524 SAINT MORITZ AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75214-2428
Country	:	US
Telephone Number	:	214-364-0225
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 W CENTERVILLE RD
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75041-5823
Country	:	US
Telephone Number	:	972-303-7021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2010
Last Update Date	:	12/17/2014

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